The widespread use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapies alone is unlikely to drown out a fundamental need for research into precision diabetes and for novel clinical approaches, said 2026 Kelly West Award recipient Mohammed K. Ali, MD, MSc, MBA.

“I think some part of the work is in defining, preventing, and treating diabetes more precisely. I think we need to think about how to navigate implementation and supply-side challenges of precision diabetes. And then there is the big one—how do we optimize demand and policy for precision diabetes?” he said.

Dr. Ali delivered these remarks on Sunday, June 7, during the Kelly West Award for Outstanding Achievement in Epidemiology Lecture. He received the honor for contributions to the field of diabetes epidemiology at the 2026 Scientific Sessions in New Orleans. On-demand access to recorded presentations, including Dr. Ali’s lecture, will be available to registered participants following the conclusion of the 2026 Scientific Sessions, from June 10–August 10.

Dr. Ali said two concepts dominated the diabetes public health field when he began his career nearly 20 years ago: the “stairway to heaven” approach, which posited that scientific research would reveal truths that could inform improvements in practice and policy, and a “one-size-fits all” approach to type 2 diabetes data that estimated average risk or response using epidemiological and clinical trial cohorts.

In the early 2000s, this approach was borne out by highly impactful studies such as the landmark National Diabetes Prevention Program (DPP), focusing on general lifestyle changes and medications in the prevention of type 2 diabetes in prediabetes.

But these insights did not lead to sustained, widespread public health gains in the United States or globally.

“We now have 40 million people with diabetes nationally. That is double what it was back in 2004, which was just a couple of years after the DPP came out,” Dr. Ali said. “So, we haven’t done a great job of translating or realizing the population benefits of the average approach.”

Dr. Ali said that in responding to this challenge, it is important to acknowledge research over the past 10 years exploring variations in biology and the heterogeneity of diabetes itself. This has led to categorizing type 2 diabetes into distinct phenotypes, each with different needs and responses, such as severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD).

This line of research has also explored psychological variation and behavioral phenotypes among those living with diabetes (such as present-focused, future-focused, risk-averse, risk-tolerant, and various combinations of those traits), which might greatly affect therapy response and adherence, Dr. Ali noted.

“I would argue that the research we need in the next decade or quarter-century needs to be thoughtful about this biological heterogeneity and precision diabetes treatment,” he said. “It also needs to be thoughtful about the psychology of our end users and how they can access anything.”

Dr. Ali said other key considerations involve moving away from blood glucose as a key measurement in defining diabetes.

“I’m hoping we can see something where our field can become a little bit more like the cancer field, where we actually look at the mechanisms driving diabetes, not the endpoint, late-downstream glucose change,” he said. “Maybe connecting peptide is one of these, maybe fasting insulin is one of these, but we need definitely to rethink how we think about diabetes and start earlier.”

Dr. Ali said that research on genotypic variation can also inform the development of GLP-1 RA therapy, with studies already showing that different subtypes respond differently to existing GLP-1 RAs.

Looking to the future of diabetes epidemiology, Dr. Ali said that much of the focus will probably be on the SIDD and MOD groups, which make up about 40% of people with type 2 diabetes.

“For the other 60%, let’s do what we can to help them lose weight and have a good quality of life,” Dr. Ali said. “The [research] agenda is big enough for all of us. We don’t need to compete, we just need to do it in parallel, learn from each other, and collaborate actively.”

The annual Kelly West Award is given by the American Diabetes Association^® (ADA) in memory of Kelly M. West, widely regarded as the “father of diabetes epidemiology.”

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Make plans to join us June 18–21, 2027, for the 2027 Scientific Sessions at the Walter E. Washington Convention Center in Washington, DC. Registration will open in January.